| NPI | 1013412956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 69882) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 238295) |
| Enumeration Date | 2018-03-23 |
| Last Update Date | 2021-07-29 |